Surgical Treatment Of Craniosynostosis Research Articles

An approach to reducing blood loss during reconstructive operations on the bones of the skull in children with craniosynostosis

Background. Radical reconstructive operations on the bones of the skull in children with craniostenoses are always accompanied by significant intraoperative blood loss. The range of blood saving methods for children is narrower than for adults. Unfortunately, the incidence of post-transfusion reactions and complications remains high, and for infants who have undergone traumatic surgery, the occurrence of such a complication can be fatal. This dictates the need to search for new and effective methods of blood saving for children, which is especially important in the surgical treatment of various forms of craniosynostosis.The objective was to evaluate the effectiveness of the developed approach to reducing blood loss during radical reconstructive operations on the bones of the skull in children. Study design: cohort, prospective studyMaterials and methods. Design: a cohort, prospective study, which included 50 children diagnosed with craniosynostosis who underwent radical reconstructive surgery on the bones of the skull. To reduce blood loss, the developed approach was used, which included hypervolemic hemodilution, the introduction of an antifibrinolytics and infiltration of the skin flap with a local anesthetic before surgical incision. During the operation, the volume of blood loss, the level of hemoglobin, hematocrit, acid-base state were recorded at 3 stages of surgical treatment. The international normalized ratio, activated partial thromboplastin time, fibrinogen concentration were evaluated before surgical treatment and at the end of surgery. A comparative analysis of approaches to replacement of intraoperative blood loss before and after the introduction of the proposed method of blood saving was carried out.Results. The level of blood loss in most cases corresponded to 1 and 2 degrees. Hemotransfusions were performed in 23 children (46%). Prior to the introduction of the proposed method of blood saving, intraoperative blood transfusion was performed in 100% of patients. Comparison of the coagulation system indicators before the operation and at the end of the 3rd stage of the operation showed statistically significant differences and corresponded to their active consumption. Evaluation of SO2, ctO2, P50 indicators at all stages of the operation showed no deviation from normal valuesConclusion. The average level of blood loss in the surgical treatment of craniosynostosis in children corresponds to 1–2 degrees. The level of consumption of blood clotting factors increases by the end of the main stage of surgical treatment, but does not reach the indicators at which there is a need to use freshly frozen plasma (NWF). A developed approach to the correction of blood loss in children with craniosynostosis, including: the use of hypervolemic hemodilution, the introduction of tranexamic acid, infiltration of the skin flap with a local anesthetic with epinephrine before surgical incision, infusion therapy in a restrictive mode after surgical incision allowed minimizing the use of blood preparations.

498 Assessing Knowledge Silos in the Craniosynostosis Literature

INTRODUCTION: The surgical treatment of craniosynostosis has traditionally been a multidisciplinary effort, involving pediatric neurosurgeons and plastic surgeons. Advances in treating this condition may result from collaboration between these two specialties, yet there exists a certain risk of sequestering clinical knowledge between the two which may limit continued progress in this regard. METHODS: During September 2020, the Scopus database was queried to identify journal articles related to craniosynostosis. Bibliometric measures were collected for each article, and a database was constructed to assess knowledge sharing between neurosurgeons and plastic surgeons. RESULTS: 5335 articles were identified. 720 (13.5%) were published in a neurosurgery journal with 499 (9.4%) published by neurosurgeons and 665 (12.5%) by neurosurgeons and plastic surgeons collaborating together. As expected, neurosurgeons published primarily (319, 63.9%) in neurosurgical journals, whereas plastic surgeons published most in plastic surgery journals (990, 65.7%). Collaborations were mostly published in plastic surgery journals (326, 49%). After normalizing for years in press, neurosurgeons were observed to be cited significantly less than plastic surgeons (p <0.0001), and articles published in neurosurgery journals were cited at a lower rate than those published in plastic surgery journals. The differential association of terms used in plastic surgery versus neurosurgery article abstracts illustrates the potential sites of knowledge silo formation in the craniosynostosis literature. CONCLUSION: This study demonstrates that a distinct sequestering of knowledge exists between neurosurgeons and plastic surgeons publishing on the topic. Publications by plastic surgeons are more highly cited than by neurosurgeons. While there are certainly specialty-based topics within craniosynostosis, we recommend continued collaboration on all research fronts to avoid sequestration of knowledge and progress.

Amount of reoperation following surgical repair of nonsyndromic craniosynostosis at a single center.

Craniosynostosis is a deformity of the skull that occurs as a result of early fusion of one or more cranial sutures and can be accompanied by neurological deficits. Craniosynostosis can be classified as syndromic or nonsyndromic according to the type of suture involved. Surgical treatment of craniosynostosis in infants basically involves loosening and opening the fused sutures to reduce intracranial pressure, allow the brain to grow, and also fix the skull shape. However, in such cases there is a risk of resynostosis after surgery. According to the literature, resynostosis rates vary between 0% and 70%. In this study, we aimed to evaluate the reoperation rate in craniosynostosis cases treated surgically in our clinic. A retrospective analysis of 70 nonsyndromic craniosynostosis cases treated surgically in the Neurosurgery Department of Bursa Uludağ University from 2005 to 2019 was performed. All patients had undergone total cranial vault remodeling surgically and had been followed up for at least a year. The study group included 70 patients, comprising 40 (57.1%) male and 30 (42.9%) female patients. The mean age of the group was 10.9 ± 7.8 months (range 3-34 months). Out of 70 patients, repeat surgery due to resynostosis had been performed once in 5 (7.1%) patients and twice in 1 (1.4%) patient. It should be kept in mind that resynostosis may occur in patients who have been operated for craniosynostosis. Patients should be examined cosmetically and if necessary, radiologically in the follow-up. Further studies based on larger sample size are recommended for more quantitative data and better results.

Thromboelastography Changes of Whole Blood Compared to Blood Component Transfusion in Infant Craniosynostosis Surgery.

Surgical treatment of craniosynostosis with cranial vault reconstruction in infants is associated with significant blood loss. The optimal blood management approach is an area of active investigation. Thromboelastography (TEG) was used to examine changes in coagulation after surgical blood loss that was managed by transfusion with either whole blood or blood components. Transfusion type was determined by availability of whole blood from the blood bank.This retrospective study examined differences in posttransfusion TEG maximum amplitude (MA), a measure of the maximum clot strength, for patients transfused with whole blood or blood components. We included all patients less than 24 months old who underwent cranial vault remodeling, received intraoperative transfusions with whole blood or blood components, and had baseline and posttransfusion TEG measured. Whole blood was requested for all patients and was preferentially used when it was available from the American Red Cross.Of 48 eligible patients, 30 received whole blood and 18 received blood components. All patients received an intraoperative antifibrinolytic agent. The posttransfusion MA in the whole blood group was 61.8 mm (IQR 59.1, 64.1) compared to 57.9 mm (IQR 50.5, 60.9) in the blood components group (P = 0.010). There was a greater posttransfusion decrease in MA for patients transfused with blood components (median decrease of 7.7 mm [IQR -3.4, 6.3]) compared with whole blood (median decrease of 2.1 mm [IQR -9.6, 7.5] P < 0.001).Transfusion with blood components was associated with a greater decrease in MA that was likely related to decreased postoperative fibrinogen in this group. Patients who received whole blood had higher postoperative fibrinogen levels.

Quantitative evaluation of local head malformations from three-dimensional photography: application to craniosynostosis.

The evaluation of head malformations plays an essential role in the early diagnosis, the decision to perform surgery and the assessment of the surgical outcome of patients with craniosynostosis. Clinicians rely on two metrics to evaluate the head shape: head circumference (HC) and cephalic index (CI). However, they present a high inter-observer variability and they do not take into account the location of the head abnormalities. In this study, we present an automated framework to objectively quantify the head malformations, HC, and CI from three-dimensional (3D) photography, a radiation-free, fast and non-invasive imaging modality. Our method automatically extracts the head shape using a set of landmarks identified by registering the head surface of a patient to a reference template in which the position of the landmarks is known. Then, we quantify head malformations as the local distances between the patient's head and its closest normal from a normative statistical head shape multi-atlas. We calculated cranial malformations, HC, and CI for 28 patients with craniosynostosis, and we compared them with those computed from the normative population. Malformation differences between the two populations were statistically significant (p<0.05) at the head regions with abnormal development due to suture fusion. We also trained a support vector machine classifier using the malformations calculated and we obtained an improved accuracy of 91.03% in the detection of craniosynostosis, compared to 78.21% obtained with HC or CI. This method has the potential to assist in the longitudinal evaluation of cranial malformations after surgical treatment of craniosynostosis.

Clinical Manifestations and Surgical Treatment of Craniosynostosis in Mosul City�Iraq

Clinical Manifestations and Surgical Treatment of Craniosynostosis in Mosul City�Iraq

Surgical Treatment of Craniosynostosis

Surgical Treatment of Craniosynostosis

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures.

OBJECTIVE To compare minimally invasive endoscopic and open surgical procedures, to improve informed consent of parents, and to establish a baseline for further targeted improvement of surgical care, this study evaluated the complication rate and blood transfusion rate of craniosynostosis surgery in our department. METHODS A prospective complication registration database that contains a consecutive cohort of all pediatric neurosurgical procedures in the authors' neurosurgical department was used. All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included. In total, 187 procedures were performed, of which 121 were endoscopically assisted minimally invasive procedures (65%). Ninety-three patients were diagnosed with scaphocephaly, 50 with trigonocephaly, 26 with plagiocephaly, 3 with brachycephaly, 9 with a craniosynostosis syndrome, and 6 patients were suffering from nonsyndromic multisutural craniosynostosis. RESULTS A total of 18 complications occurred in 187 procedures (9.6%, 95% CI 6.2-15), of which 5.3% (n = 10, 95% CI 2.9-10) occurred intraoperatively and 4.2% (n = 8, 95% CI 2.2-8.2) occurred postoperatively. In the open surgical procedure group, 9 complications occurred: 6 intraoperatively and 3 postoperatively. In the endoscopically assisted procedure group, 9 complications occurred: 4 intraoperatively and 5 postoperatively. Blood transfusion was needed in 100% (n = 66) of the open surgical procedures but in only 21% (n = 26, 95% CI 15-30) of the endoscopic procedures. One patient suffered a transfusion reaction, and 6 patients suffered infections, only one of which was a surgical site infection. A dural tear was the most common intraoperative complication that occurred (n = 8), but it never led to postoperative sequelae. Intraoperative bleeding from a sagittal sinus occurred in one patient with only minimal blood loss. There were no deaths, permanent morbidity, or neurological sequelae. CONCLUSIONS Complications during craniosynostosis surgery were relatively few and minor and were without permanent sequelae in open and in minimally invasive procedures. The blood transfusion rate was significantly reduced in endoscopic procedures compared with open procedures.

Increases in Cranial Volume with Posterior Cranial Vault Distraction in 31 Consecutive Cases

Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume. To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3-dimensional (3-D) photogrammetric imaging or plain skull radiographs. All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included. All patients were followed at outpatient clinics with plain radiographs performed for follow-up. In 5 patients, additional 3-D photogrammetric imaging was done pre- and postoperatively. The mean intracranial volume increase was 25.0%, ranging from 16.9% to 39.4%. In 5 patients, the increase in volume was calculated from the photogrammetric 3-D images comprising a mean of 17.4%. Volume calculations from cephalograms in the same patients gave a mean of 20.8%. Whether the distraction was a primary operation or patient had undergone previous cranioplasty did not influence the achieved volumetric results. There were no statistically significant differences in the distraction results between different diagnostic groups. PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3-D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.

Surgical treatment of craniosynostosis in infants: open vs closed repair.

Correction of craniosynostosis may require extensive surgical interventions with related intra and postoperative complications especially hemorrhage. To reduce the intervention's impact and associated complications, less invasive surgical alternatives have evolved. The present review comprehensively summarizes surgical techniques, perioperative anesthesia management, success rates, complications, the results of outcome evaluations, and predictors of intra and postoperative complications. Recent evaluations suggest that less invasive methods represent valuable techniques with comparable cosmetic and volumetric results but reduced overall impact and complications. Furthermore, risk stratification based on predictors might optimize safety and guide decision-making concerning the required level of postoperative clinical care. Neuroendoscopic techniques, designed to minimize surgical incision, dissection, and blood loss, are becoming efficacious and valuable alternative therapeutic options reducing the need for fluid replacement and invasive hemodynamic monitoring. Since hemorrhage represents the most important complication in open craniosynostosis repair, prevention strategies such as the use of tranexamic acid should be considered. Sufficient correction of entailed coagulopathies is crucial.

Clinical applications of molecular basis for Craniosynostosis. A narrative review.

Cranial sutures are specialized structures composed of the sutural mesenchyme, the overlying scalp, the dura and osteogenic fronts. Each one of these structures express important proteins for osteogenic maturation, membranous ossification of skull bones, and homeostasis of cranial sutures in a differential, spatial and temporal manner. These proteins include fibroblast growth factor (FGF) and its receptors (FGFR), the transforming growth factor beta (TGF-β), bone morphogenetic proteins (BMPs), as well as transcription factors TWIST and MSX2, among others. The alteration in the expression of one or more of these proteins causes multiple pathological conditions, one of them is the premature closure of one or more cranial sutures, known as craniosynostosis. This malformation is commonly treated with surgery. However, advances in the fields of molecular and cellular biology have allowed to conduct research on some proteins involved in the development of craniosynostosis. The results of these studies can lead to future preventive therapeutic strategies that may be used as a complement to the surgical treatment of craniosynostosis. Possible strategies include the use of specific drugs that can regulate the expression and activation of FGF signaling pathways, TGF-β or BMPs, to prevent or avoid craniosynostosis or re-synostosis after a surgery.

Odilon Marc Lannelongue (1840–1911) and strip craniectomy for craniosynostosis

In the 19th century, Dr. Odilon Marc Lannelongue was a pioneering French surgeon who introduced a surgical technique for the treatment of craniosynostosis. In 1890, Dr. Lannelongue performed correction of sagittal synostosis by strip craniectomy. From his procedure, multiple techniques have been developed and endorsed for this condition, ranging from simple suturectomies to extensive calvarial vault remodeling. In addition, even today, endoscopically aided strip craniectomy is performed as a surgical treatment of craniosynostosis. This article describes the life and works of the surgeon who revolutionized the management of craniosynostosis.

Simultaneous Fronto-Orbital Advancement and Dynamic Posterior Cranial Vault Expansion in Apert Syndrome

Craniosynostosis in Apert syndrome is routinely treated by wide frontal and bilateral supraorbital reshaping and posterior cranial decompression. Dynamic cranial vault expansion has proved to be useful in craniofacial surgery, and its use has extended to syndromic patients. Although a controversy remains between conventional osteotomy and application of the spring-mediated technique in surgical treatment of craniosynostosis, there have been several positive clinical reports on expansion techniques for nonsyndromic and syndromic craniosynostosis. Simultaneous fronto-orbital advancement and posterior cranial vault expansion have been applied successfully to 2 patients of Apert syndrome, without intraoperative complications or postoperative morbidity and improving final cranial shape.

Surgical treatment of craniosynostosis at an oral and maxillofacial center in an inland city of Brazil: initial experience with five cases

Surgical treatment of craniosynostosis at an oral and maxillofacial center in an inland city of Brazil: initial experience with five cases

Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures

To review the complications in the surgical treatment of craniosynostosis in 306 consecutive transcranial procedures between June 1999 and June 2007. Surgical series consist of 306 procedures done in 268 patients: 155 scaphocephalies, 50 trigonocephalies, 28 anterior plagiocephalies, one occipital plagiocephaly, 20 non-syndromic multisutural synostosis and 32 craniofacial syndromes (11 Crouzon, 12 Apert, seven Pfeiffer and two Saethre-Chotzen) Complications and time of hospitalisation were reckoned. Surgical procedures were classified in 12 different types according to the technique: Type I: frontal-orbital distraction (26 cases); Type II: endoscopic assisted osteotomies in sagittal synostosis (39 cases); Type III: sagittal suturectomy and expansive osteotomies (44 cases); Type IV: same as type III, but including frontal dismantling or frontal osteotomies in scaphocephalies (59 cases); Type V: complete cranial vault remodelling (holocranial dismantling) in scaphocephalies (13 cases); Type VI: frontal-orbital remodelling without frontal-orbital bandeau in trigonocephaly (50 cases); Type VII: frontal-orbital remodelling without frontal-orbital bandeau in plagiocephaly (14 cases); Type VIII: frontal-orbital remodelling with frontal-orbital bandeau in plagiocephaly (14 cases); Type IX: Occipital advancement in posterior plagiocephaly (one case); Type X: Standard bilateral front-orbital advancement with expansive osteotomies (28 cases); Type XI: holocranial dismantling (complete cranial vault remodelling) in multisutural craniosynostosis (12 cases); Type XII: occipital and suboccipital craniectomies in multiple suture craniosynostosis (six cases). There was no mortality and all complications resolved without permanent deficit. Mean age at surgery was 6.75 months. Most frequent complication was non-filiated postoperative hyperthermia (13.17% of the cases) followed by infection (8.10%), subcutaneous haematoma (6.08%), dural tears (5.06%) and cerebrospinal fluid (CSF) leakage (2.7%). Number and type of complications was higher among the group of reoperated patients (12.8% of all): 62.5% of all the series infections, 93% of all dural tears and 75% of all CSF leaks. In relation to surgical procedures, endoscopic assisted osteotomies reported the lowest rate of complications, followed by standard frontal-orbital advancement in multiple synostosis, trigonocephalies and plagiocephalies. Highest number of complications was related to complete cranial vault remodelling (holocranial dismantling) in scaphocephalies and multiple synostoses and after the use of internal osteogenic distractors. Special consideration deserves two cases of iatrogenic basal encephaloceles after combined frontal-facial distraction. Finally, we establish considerations based on the complications related to every specific technique. Percentage and severity of complications relates to the surgical procedure and is higher among patients going for re-operation. Mean time of hospitalization is also modified by these issues.

First Cuban CME Course on Pediatric Neurosurgery, Havana, Cuba, 15–17 June 2006

The First Cuban Course on Pediatric Neurosurgery, Havana 2006, organized by the International Society for Pediatric Neurosurgery (ISPN), was held in Havana, Cuba, on 15, 16, and 17 June. Dr. Tania Leyva Mastrapa (chairperson), Dr. Julio Brossard Alejo (cochairman), and Dr. Luis Alonso Fernandez (secretary) were on charge of the local organizing committee. A total of 76 delegates from Latin America, Africa, and Europe registered for this important event. Members of the international faculty were Prof. Edgardo Schijman (Buenos Aires, Argentina) as the scientific chairman, Prof. Concezio Di Rocco (Rome, Italy), Prof. Shizuo Oi (Tokyo, Japan), Prof. Bruce Storrs (Florida, USA), Prof. Charles Teo (Sidney, Australia), and Prof. Enrique Ventureyra (Ottawa, Canada). Hydrocephalus, neuroendoscopic surgery, open and closed spinal dysraphisms, management of intracranial arachnoid cyst, surgery of supratentorial and infratentorial tumors, and surgical treatment of craniosynostosis were the main topics discussed at the course sessions at which formal presentations were followed by a very interesting interaction between the faculty and young delegates. The evening social activities, the walks along the Malecon—the world famous Havana side-sea avenue— and the strolls around the historical streets of Old Havana, were carried out in a very relaxed atmosphere. This First Cuban Course on Pediatric Neurosurgery was considered a very successful event by delegates and by the foreign faculty as well. Hence, it is the intention of the local neurosurgical society to request the ISPN to organize a second course on Pediatric Neurosurgery in Cuba in 2008. The main objective of the course, the education in pediatric neurosurgery to young and to not so young neurosurgeons, was achieved and as an immediate result of the course is the fact that many young neurosurgeons in Cuba feel motivated to specialize in pediatric neurosurgery. Childs Nerv Syst (2007) 23:599 DOI 10.1007/s00381-007-0311-z

2. 頭蓋骨縫合早期癒合症の外科治療(MS2-6 小児脳神経外科治療のスタンダード, 第27回 日本脳神経外科コングレス総会)

2. 頭蓋骨縫合早期癒合症の外科治療(MS2-6 小児脳神経外科治療のスタンダード, 第27回 日本脳神経外科コングレス総会)

The Progression of Head Circumference following Surgical Treatment of Craniosynostosis

The Progression of Head Circumference following Surgical Treatment of Craniosynostosis

Hybrid of Distraction Osteogenesis Unilateral Frontal Distraction and Supraorbital Reshaping in Correction of Unilateral Coronal Synostosis

Unicoronal synostotic plagiocephaly is routinely treated by intracranial wide frontal and bilateral supraorbital reshaping. Recent advancement of distraction osteogenesis in craniofacial surgery has extended to patients with craniosynostosis. Although a controversy remains between conventional osteotomy and reshaping and application of the distraction technique in surgical treatment of craniosynostosis, there have been several positive clinical reports on distraction techniques for nonsyndromic and syndromic craniosynostosis. Unicoronal distraction applied successfully to a case of frontal plagiocephaly has been described. The authors report a procedure: hybrid of unilateral frontal distraction and supraorbital reshaping on the affected side for frontal synostotic plagiocephaly. This procedure was conducted on four typical unicoronal synostotic plagiocephaly cases (patient age range, 9-14 months; all patients female) with successful results. No particular complications were encountered in any of the four cases with a follow-up period that ranged from 18 to 53 months.

819 Venous Air Embolism during the Surgical Treatment of Craniosynostosis Using Minimally Invasive Techniques

819 Venous Air Embolism during the Surgical Treatment of Craniosynostosis Using Minimally Invasive Techniques